Episiotomy – Definition, Recovery and Complications

An episiotomy is defined as a cut/incision made to the perineum to widen the delivery canal of the baby during child birth. Episiotomy is done to prevent severe tearing up of perineum by the body to deliver the child. Usually episiotomy is done when the child to be born has a problem coming out and in distress and at risk of losing life.

Why is episiotomy done?

When the baby is in distress and wants to come out and if the vagina and the muscles around it are unable to stretch as much as they should to allow the baby to exit, the perineum area tears up to make the birth canal bigger. Tearing of perineum can be expected when the woman is delivering the baby for the time or if the baby is very large or has a larger head or if the mother is overweight or obese.  If the baby can be delivered through the vaginal canal normally, episiotomy may not be needed.

Your gynecologist will go for an episiotomy if:

1. If the baby needs to be delivered quickly or if there is any delivery complication such as cord compression.
2. If the head or shoulders of the baby are too large to fit in through the vaginal canal.
3. If the baby is in a breech position (with feet or buttocks coming out first instead of head).
4. If assisted delivery is needed by using forceps or vacuum extractors.
5. If the tear is being formed towards the urethral area when the mother is pushing out the baby.

How is episiotomy done and types of episiotomy

During delivery, a small incision or cut is made in the perineum area. (Perineum is the place between the vagina and the anus). Local anesthesia would be administered before making the incision or if an epidural was given, the dose may be topped up before episiotomy. The cut is made during the second stage of labour (before the head of the baby is delivered).

Types of Episiotomy

1. Midline (Median) Incision. This is the most common type of episiotomy where in a cut is made in the middle between the vagina and the anus. Midline incision is easier to heal but there is a risk that this cut may tear up to the anus during delivery.
2. Mediolateral Incision. Instead of making the cut in the middle, this type of incision is made at an angle. Such an incision is difficult to heal and also more painful but reduces the risk of tearing up to the anus.

Once the baby is delivered, the incision is stitched up with dissolvable stitches that typically heal in a week to 10 days. Complete healing of perineal incision may take up to 6 weeks.

Preventing episiotomy or reducing the odds of episiotomy

1. If you are overweight or obese, plan to become pregnant after you reach ideal healthy weight. Along with the risk of episiotomy, this reduces a lot of risks and is also good for your overall health.
2. Keep working out regularly even when you are pregnant. Unless your doctor advises you complete bed rest or to rest your back, you should work out moderately even when pregnant to remain in good health and keep your body stretchable.
3. Keeping the body hydrated and also working out the pelvic muscles to give them more flexibility and strength.
4. Prenatal Perineal Massage, warm compresses reduces the need for episiotomy.
5. If you don’t want to have an episiotomy done during delivery, you must keep your gynecologist informed before labor.

Recovering from episiotomy incision

Recovering from the expansion of vaginal canal and the episiotomy incision is a painful journey for a woman. The pain and discomfort can last from a week to 6 weeks until complete healing takes place. Your gynecologist may advise you to:

1. Apply ice packs regularly near the vagina can help reduce the swelling and pain.
2. Taking warm bath can provide relief from pain.
3. Pain killers and antibiotics should be taken as prescribed by your doctor.
4. Sitz bath covering the vulva area few times a day can help soothe the pain.
5. If you are using pads, changing the pads regularly thrice or four times a day is a good idea.
6. Wash the area with warm water after urinating and passing stools.
7. Do not participate in sex until your doctor gives you a green signal.
8. Avoid lifting heavy weights until complete healing happens.

Complications due to episiotomy

A woman who had an episiotomy typically takes longer to heal compared to those who didn’t have one.  Complications of episiotomy include:

1. Blood loss or haemorrhage
2. Pain, Swelling and inflammation of the area
3. Possibility of infection as the incision is very close to the anus
4. Damage of anal sphincter and rectal muscles during episiotomy. If the anal sphincter is damaged, that can result in faecal incontinence.
5. Perineal hematoma (collection of blood at the incision site)